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The role of distress in female sexual dysfunction during menopause

Nature Medicine volume 31, pages 1381–1383 (2025)Cite this article

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Female sexual dysfunction (FSD) has historically received less attention than male sexual dysfunction, in terms of research, diagnosis and treatment, for various reasons, including culturally specific societal stigma, lack of awareness and diagnostic complexities. Sex-hormone insufficiency has long been considered a primary cause of FSD1, particularly during menopause. Menopause marks the end of reproductive capabilities, but it is also widely perceived as a period of sexual function decline2. However, although menopause undeniably brings hormonal adjustments, the link with FSD is complex. For example, we conducted a narrative review of over 200 studies on changes in sexual function during the perimenopausal period (stage –2 to stage +1 according to The Stages of Reproductive Aging Workshop + 10 staging system) and found that postmenopausal status alone does not associate with FSD (as summarized in Table 1), particularly when a diagnosis of distress was incorporated into the survey. Other psychological and relational factors influence the sexual health of middle-aged women and might exert a greater effect than the hormonal changes associated with menopause3.

Table 1 Studies investigating the relationship between menopause and female sexual dysfunction
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Research has consistently shown a decline in sexual function during the postmenopausal period, which can be evaluated through the use of tools such as the Female Sexual Function Index (FSFI) and the Short Personal Experiences Questionnaire (SPEQ). The Melbourne Women’s Midlife Health Project, a longitudinal cohort study conducted in Australia, observed over 400 premenopausal women 45–55 years of age at baseline. This study measured sexual function and hormone levels annually with SPEQ for 8 years, showing that as menopause progressed, the proportion of women with low sexual function (SPEQ ≤ 7) increased from 42% to 88%. Alongside this, there was a substantial decline in desire, arousal, orgasm, lubrication and frequency of sexual activity, accompanied by an increase in dyspareunia4. In further support of these results, a prospective cohort study of 1,525 British women followed annually from 47 to 54 years of age showed that compared with remaining premenopausal, becoming postmenopausal independently decreased sexual satisfaction and increased intercourse difficulties5. Similarly, The Penn Ovarian Aging Study, which included 218 African American and 218 white women and used the FSFI scale, identified postmenopausal status as a risk factor for low sexual function (FSFI < 20). The Seattle Midlife Women’s Health Study noted a decrease in desire with menopause progression. The Study of Women’s Health Across the Nation cohort, which started in 1996 with over 3,300 premenopausal women of various ethnicities 42–52 years of age, found a decline in sexual function score mainly in the 20 months leading up to the final menstrual period and continuing 1 year after, decreasing by 0.35 annually (95% confidence interval (CI), 0.44–0.26), and then slowing (0.13 annually; 95% CI, 0.17–0.10). Notably, African American women had a smaller decrease in sexual function, while Japanese women experienced a greater decline.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Jiali Duan, Rong Chen & Lan Zhu

  2. Vanke School of Public Health, Tsinghua University, Beijing, China

    John S. Ji

  3. Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne and the Royal Women’s Hospital, Melbourne, Victoria, Australia

    Martha Hickey

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  1. Jiali Duan
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  2. John S. Ji
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  5. Lan Zhu
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Corresponding author

Correspondence to Lan Zhu.

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Competing interests

M.H. declares salary funding from the Australian National Health and Medical Research Council, support for meeting attendance from the UK National Institute for Health and Care Excellence, and the following roles: principal investigator for a clinical trial of salpingectomy versus salpingo-oophorectomy for prevention of ovarian cancer (TUBA-WISP II); board member for Breastscreen Victoria; editor for the Cochrane Collaboration; recipient of a fellowship from the Danish Lundbeck Foundation (2022-23); site investigator for a clinical trial of a non-hormonal agent (Q-122) for vasomotor symptoms in patients with breast cancer (QUE Oncology, 2020-22); and site investigator for a clinical trial of a medical device for treating vaginal dryness (Madorra). All other authors declare no competing interests.

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Duan, J., Ji, J.S., Chen, R. et al. The role of distress in female sexual dysfunction during menopause. Nat Med 31, 1381–1383 (2025). https://doi.org/10.1038/s41591-025-03593-y

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